How to help a child who feels COVID-19 burnout

By Dr. Diana Graham and Dr. Christopher Min, pediatric psychologists at CHOC

For many of us, the COVID-19 pandemic has created a “new normal” as efforts to curb the spread of the virus have changed what day-to-day life looks like. It can be difficult to balance maintaining our physical and mental health while also supporting one another.

Over the last several months, many parents and guardians have tried their best to think of creative ways to help children understand the dangers of COVID-19 while also trying to limit its interference with their children’s quality of life. Kids and teens alike are struggling with the challenge of increased isolation from friends, barriers to traditional academic instruction, and uncertainty about the current events of the world, all without their usual outlets of fun and stress relief. This may result in children becoming burnt out during the era of COVID-19.

As a parent you may notice signs of the following symptoms in your child who feels burnt out by the COVID-19 pandemic: increased irritability, changes in sleep and/or appetite, less motivation to engage in things that used to interest them, withdrawal from others at home and/or increases in levels of reassurance they need due to uncertainty of current events.

Here are some things you can do to help your child if they are struggling with their mental health during COVID-19.

Help them engage in a consistent routine

Having structure and routine most days can help reduce your child’s reliance on screens, their anxiety related to COVID-19 uncertainty and changes, and increase their feeling of purpose during a time that typical go-to activities may be restricted.

  • Start with thinking about what a typical day looks like for your child. Do they have online schooling or a hybrid of in-person and online schooling? What types of chores do they need to get done? Do you want them to get some physical activity each day?
  • Next, decide whether it would be most helpful to schedule by the hour or in chunks of time (e.g., 9 a.m.-noon) in their routine. Be careful to not overschedule (e.g., every 30 minutes), as this may be too difficult for both you and your child to follow long-term.
  • Scheduling in sleep and meal routines can help your child remain on a schedule similar to the one they follow during a typical school year. Having consistent sleep, wake and meal schedules can also help your child regulate their mood and manage stressful situations.
  • Make these schedules visual for your child to see and follow. Put the schedule in a place that your child will most likely see, such as on the bathroom mirror, making it more likely to become their norm.

Schedule flexibility into your routine

While it is important to have consistency, it is also very important to be flexible with routines because, as we all know, life can get in the way! Having this flexibility allows your child to have an element of control during a very uncertain time, which can often help with managing anxiety. Here are some small ways to build flexibility into your child’s schedule:

  • First, choose a couple of activities in your child’s schedule that allows for several choices to pick from. They can choose what food they want for lunch, or pick what to play during game time. Here’s a roundup of activity ideas for kids during COVID-19.
  • Make lists of a three to four different choices available throughout the day for the activities on your schedule. For example, your child may have lunch at the same time every day but can have a list of different food options to choose from.

Keep your child moving

We are staying at home now more than ever, making it difficult to stay active and get “brain breaks.” However, we know that being more active can have a positive impact on our mood, ability to manage stress, and ability to focus. Here are some tips to include physical activity into your child’s daily schedule:

  • Schedule in time for a physical activity to ensure that your child’s brain is getting the break it needs, especially from screens. Research has shown that recess at school can help children to stay on task and increase sustained attention.
  • Keep a varied list of COVID-19-friendly physical activities that your child can choose from to help decrease sedentary behavior. Examples may include jumping jacks, YouTube yoga, a household dance party, and even taking a walk around the block while listening to music. Remember to practice physical distancing if exercising outdoors.
  • Although physical activity is beneficial throughout the entire day, studies show that exercise between 4 p.m. and 6 p.m. can help a child’s ability to fall asleep and stay asleep. If your child is having sleep difficulties, time your child’s exercise activities to help promote more restful sleep.
  • It can be challenging to motivate your child to be active when they are feeling burnt out. If your child seems uninterested in engaging in a physical activity, try to schedule it at a time when another person in the household can participate so that it can feel more fun and socially engaging rather than punishing. Or, they can take an online yoga class with a friend. As this becomes a more regular part of your child’s routine, it will likely become easier. For school-aged children and teenagers, it can also be helpful to collaborate with them on the list of choices for physical activity to increase their engagement when it becomes time to be active.

Normalize not always being OK

Kids learn from those around them. Let your child know that it’s OK to feel uneasy about how things are right now.

  • You can do this by modeling good coping skills when you make a mistake or don’t have the answer to something and recognizing the uncomfortable emotions that might come along with this experience.
  • Sometimes labeling emotions is enough to help validate your child’s experiences. By showing and discussing all the different emotions you may be experiencing during a difficult situation, it will help normalize this type of emotional processing for your child too.
  • Create opportunities with your child to discuss how challenging COVID-19 is for so many people, the different ways these challenges may show up in our daily lives, and to brainstorm ideas on how to cope. This can build a pattern of communication in which your child notices warning signs of burn out sooner and can let you know when they need help.

Learn how to cope together

Engaging in family activities together can be a good way to decrease the likelihood of experiencing feelings of social isolation and give you and your child shared goals. By learning these coping skills together, it models for your child that it is OK if we do not feel happy all the time and there are ways that we can help manage challenging feelings.

  • Consider regular family game nights where each person gets a turn choosing the game. Other examples may include an at-home scavenger hunt or a puzzle that the family takes time to work on each day. This provides both consistency and flexibility, in addition to social interaction.
  • One fun idea can be to set family challenges each week. You may have a week where each day involves practicing a different coping skill (e.g., deep breathing, guided imagery, stretching or journaling) or a week where each person shares something that they are grateful for. Whoever can complete the most challenges during the week gets a reward, such as choosing Saturday night dinner or the next movie for family movie night. If there is a tie, then you can always split up portions of the fun night that each person gets to choose, such as one person choosing the movie and another choosing the meal.

When is this all not enough?

Let’s face it, we don’t always have all the resources to implement every strategy whenever we need it. Or, you may encounter situations where you try every recommendation and still notice concerning changes in your child. Either way, it is OK to ask for help.

  • Be aware that you are only one person and many of us are forced to function without our typical support networks such as extended family and childcare centers because of COVID-19 restrictions. Consider some other avenues of support that may be helpful for you and your child to decrease burn out and help manage coping during the pandemic.
  • Reach out to your child’s teacher or school counselor for support. Are they able to check in with your child more often? Have they noticed any changes in your child’s school engagement beyond what they think is typical right now? They may be able to provide more frequent or regular support.
  • If you become concerned about your child’s mental health, contact your primary care physician. You can also call your insurance company for a list of in-network mental health professionals or do a search online for local mental health providers.

Here are additional mental health resources for your child during COVID-19

Help Lines

  • Substance Abuse and Mental Health Services (SAMHSA) Disaster Distress Helpline
    • Toll-Free: 1-800-985-5990 (English and Español)
    • SMS: Text TalkWithUs to 66746
    • SMS (español): Text “Hablanos” al 66746
    • TTY: 1-800-846-8517
    • Website — English| Website — Español
  • National Suicide Prevention Lifeline: 1-800-273-8255
  • Crisis Text Line: Text HOME to 741-741
  • Orange County Crisis Assessment Team:

Apps

  • MindShift: a cognitive behavior therapy-based app from Anxiety Canada that helps kids to learn about and track anxiety, as well as coach them through coping skills
  • Headspace: A mindfulness app for everyday life
  • Smiling Mind: An app that guides helpful coping skills based on age

How to help kids cope with social isolation during the COVID-19 pandemic

By Dr. Hannah Greenbaum, neuropsychology postdoctoral fellow at CHOC and Dr. Melanie Fox, pediatric psychologist at CHOC

As we have taken important steps to practice physical distancing throughout the COVID-19 pandemic, virtually all children and teens have had much less interaction with their peers than they typically would.

Peer support is a very important part of childhood and adolescence, as friendships provide support, mitigate feelings of loneliness and boredom, help build a sense of belonging, and encourage identity development. As caregivers, it is important that we promote resilience and help children cope with not being around their peers during this time. For any caregivers who are struggling with how to help children cope with social isolation, there are many things you can do to help:

Encourage creative ways to connect with others

Help your child come up with creative methods of spending time with their friends. The safest way for your child to talk or play with people outside their household during this time is through video chats or phone calls. One way is to encourage a weekly video chat with a friend or family member. Older children and teens may prefer texting or playing online games with friends. This might require temporarily loosening rules about daily screen time. Children might also enjoy writing letters to their friends. Here’s a few more ideas:

  • Schedule “social time” each day, so your child can look forward to it.
  • Scavenger hunt walk in the neighborhood
  • Create arts and crafts together with friends. Choose a project and supplies in advance and make the same craft as friends over video chat.
  • Video chat with other family members and friends.
  • Set up calls or video chats to allow your child to spend time with extended family and other people important to him or her. You might ask a relative to read a story to your child over the phone or on a video chat. Or, invite family members or friends to a video chat party.

Seek daily purpose

Kids and teenagers often thrive on daily purpose. Spending time doing activities they care about or value can give your child’s day meaning and help them cope with social isolation. Your child might find meaning through reading, biking, creating music, making movies, baking, dressing up, drawing, writing, planting a garden or building something.

Encourage your child’s unique creativity. To motivate them, consider organizing a family reward board, where for example, by doing something like riding their bike they can earn a sticker working toward movie night.

Older kids might enjoy researching a topic that they’re passionate about and sharing what they’ve learned with friends.

Children and teens often feel rewarded when they help others. Consider encouraging them to find ways to connect with their larger community, like making crafts for the local senior facility, picking up litter around the neighborhood, doing yard work for a neighbor, or finding a safe way to volunteer.

Talk about feelings

Your child might feel sad about missing an important social event, such as a birthday party. Acknowledge your child’s loss, ask about his or her feelings, and validate them by showing that you understand. Allow your child to lead the discussion, rather than making assumptions about how he or she thinks and feels.

You also might consider giving your child an age-appropriate book that deals with loneliness. This can give your child words to describe his or her feelings. Or, have your child write down what they miss about certain people, places or events as a way to cope. Also, explore different ways he or she might cope with these kinds of losses, such as having a different kind of birthday celebration or planning something for when social distancing is no longer needed. Here’s more tips for talking to kids about disappointment and celebrating special events in a creative way.

Your wise mind vs. your emotion mind

Your wise mind can take in new information, be flexible considering alternatives, and be creative in thinking of solutions. Your emotion mind will urge you to give up, act impulsively or rage. Wait for your wise mind to lead, and make decisions and problem solve with your wise mind.

We cannot control the pandemic, but we can control what we do with it. Your child cannot control the current need for social distancing, but they can control how they choose to deal with the circumstances.

By encouraging your child to connect with others, share his or her feelings, and find daily purpose, you’ll help him or her cope with inevitable challenges associated with this pandemic. Working through this challenge also might contribute to your child’s personal growth and better prepare him or her to deal with future obstacles.

We know children and teenagers will continue to struggle being separated from friends as the pandemic continues. Given the importance of peer support, try to acknowledge the loss your children are experiencing, and work in your wise mind to problem-solve and find ways to continue to find peer support. After all, as the Beatles so eloquently stated, “I get by with a little help from my friends.”

11 ways parents can help children cope with fires

With brush and wildfires becoming more common in Southern California and many other parts of the world, it’s understandable that children may experience emotional distress, even if their home is not physically affected.

Here are 11 tips from The National Child Traumatic Stress Network and CHOC experts that can help parents and caregivers support kids in coping with fires:

Know these responses are common

Children may feel additional fear and anxiety during a fire – and even long after it is extinguished. Separation anxiety is common, and children may show changes in appetite, school performance and mood. Older children may show an increased likelihood for self-harm and younger children may exhibit regressive behaviors, or showing behaviors they used when they were younger.

Limit media exposure

Monitor children’s media consumption – on television, newspapers, radio and social media. Images of burning buildings or the aftermath of a fire could be frightening to children, as could reading or hearing accounts of the fire. Learn more about the importance of monitoring your child’s news and social media intake.

Monitor adult chatter

Remember that children can overhear conversations between their parents and other adults. They might also misinterpret this information, or be afraid of something they don’t understand. Keep conversations in front of children light and save heavier discussions for private.

Encourage open communication

Children may have questions about the fires – and they may ask them multiple times. Encourage kids of all ages to ask these questions as many times as they need. Use this time to address any misinformation your child might have picked up at school or elsewhere.

Provide age-appropriate information

Limit the information that you provide to your child to the questions that they ask you, to avoid overwhelming them with information that they may not already have been exposed to. Keep in mind their age and emotional maturity when answering.

Remind your children that they are safe

Share your family’s plan to keep safe. Show them where your smoke detectors are located; teach and remind them what to do if those alarms go off. Also, remind children that firefighters and other emergency personnel are working hard to protect them and their homes.

Maintain routines and expectations

Routines are essential to helping children feel safe and secure. Stick to regular schedules, mealtimes and bedtimes as best as possible and ensure children get enough rest, nutrition and exercise. Try to stick to family rules around practicing good behavior, respect and kindness, as well as other family norms, to keep a sense of normalcy.

Increase your patience

Even with routines and rules still in place, practicing flexibility and patience will be key. Distressed or distracted children might need help or additional reminders about chores and responsibilities.

Provide additional support at bedtime

Fears and anxiety could be heightened at bedtime. To avoid your child developing separation anxiety, try to spend more time with them doing light, peaceful activities like reading a book or singing songs. If a child needs to sleep with their caregiver, it’s OK. Just be clear that typical sleeping arrangements will resume in the future.

Model behavior

A parent’s crisis response will significantly influence how children respond. Remember to take care of yourself as well by eating well, sleeping well and exercising. Support your partner or other adults in your life, and, if possible, delay making any hasty decisions during a stressful time.

Read a book

Your child may feel more comfortable opening up about their feelings over the fire by reading a book where the characters experience a fire as well. “Trinka and Sam: The Big Fire” is available for download in English and also available for download in Spanish from The National Child Traumatic Stress Network.

Many of the above reactions are normal after children are exposed to something traumatic like a fire. Parents may wonder at what point their child needs further support from their pediatrician or  mental health provider. Generally if these responses continue more often than not for over two weeks and interfere with normal activities —such as school — or with sleeping or eating, then it may be time to reach out to your child’s doctor or a therapist.

Talking politics with your kids: Advice for parents

With election season here, it’s hard to miss the onslaught of media coverage and chatter about political issues and candidates. While this is an important time for our country, it can be overwhelming for parents wondering how to talk to kids about politics.

“Politics are front and center right now, making it a great time to talk to kids about the democratic process,” says Dr. Mery Taylor, a CHOC pediatric psychologist. “It’s not something that is abstract – we are all watching it unfold. Now that many kids are back in school, there is sure to be buzz about current events. It’s important for parents to get ahead of the information so they can be prepared.”

Starting a conversation with kids about politics

Dr. Taylor encourages parents to start with the basics. Here are some conversation starters she encourages parents to use:

  • What is a democracy?
  • What are the roles of people in elected office?
  • Why is this happening now?

Next, emphasize your personal responsibility as a citizen to vote, Dr. Taylor says.

“Talk to your kids about what it means to have elected officials that represent the diverse society we live in, and how that helps everybody,” she says. “Discuss the values that are important for your family. It is likely your children know who you will be voting for, but why?”

Parents can use a discussion on politics and the election as a way to model their critical thinking process for their children. To do that, Dr. Taylor encourages parents to talk about the values that shape their decision.

“Explain to your children the process of evaluating candidates’ policies and the impact of those policies on individuals, the environment and the American society as a whole,” Dr. Taylor says. “Children and adolescents are naturally curious creatures and you might be surprised by the questions that they will ask. You may find a conversation with your child or teen might even help you to articulate your own views more clearly.”

Parents can also tailor this conversation to their child’s personal interests, Dr. Taylor says.

“Focus on things that your child cares about. Are they passionate about saving turtles? Help them learn about candidates’ views on animal welfare. Do they want to be a business owner someday? Help them research candidates’ views on small business. Are they interested in health and science? Find out about the candidates’ policies on science and education funding,” Dr. Taylor says. “There are sure to be issues that speak to your child’s interest and help them feel connected to the election, and why politics matter as a whole.”

Share your plan to vote with your child. Take them along to the mailbox or polling station, depending on your voting plan.

How to deal with your child’s stress over the election

If you think your child is probably not affected by the election process, think again – this can be an overwhelming and stressful time for children and teens as well. Dr. Taylor offers the following tips for parents worried about how to talk to kids about politics:

Acknowledge your children’s feelings

Ask what they feel and why. Listen closely and try to connect with your child’s emotions before problem solving. If they have concerns or fears about a particular issue or how it may affect your family, reassure them that they are safe and that your family will work out any issue together.

Keep the conversation positive

 Focus on the positive aspects of a candidate or an issue. Take this opportunity to explain to your kids how to voice their opinions with respect, even when he/she doesn’t agree with someone else. Talk about what you believe and why in a respectful way, too. For younger children, keep the conversation light. For teens, ask them what they’ve heard at school, and/or what they’re unclear about – their answers may surprise you.

Talk about the election process

Explain to them that everyone has a voice. While they may not be able to vote, encourage your kids to get involved at school or in the community with issues that are important to them, such as the environment or the economy, for example. Let them know their contributions can make a big difference.

20+ tips for maintaining and strengthening a family bond during a hospitalization

We understand how important it is to visit loved ones during a hospitalization, especially a child’s. However, for the safety of our patients, families, physicians and staff, CHOC strictly enforces limited visitation on our campus during times such as flu season and the COVID-19 pandemic.

Our pediatric psychologists and child life specialists have teamed up to offer families the following creative ways to stay connected throughout a hospitalization:

  1. Phone calls and video chats are often the easiest ways to stay in touch with a hospitalized loved one. If a patient does not have access to a smart device, the Cherese Mari Laulhere Child Life Department can make special arrangements.
  2. Explore new apps to stay in touch – does the child or teen in your life love using WhatsApp, Messenger, Google Hangouts, Snapchat or other apps? Download their favorite app as an easy way to stay in touch their preferred way.
  3. Send an e-card to a patient at CHOC Hospital.
  4. Use the voice recorder on your smartphone to sing your child’s favorite song, read them a short story, or tell them goodnight or good morning. The parent or guardian who is at the child’s bedside can play the messages on your behalf.
  5. Write to each other in a journal. The child can write a note or draw a picture, and then send the notebook home with the visiting caregiver. Any family members who are at home and unable to visit the hospital can write messages or draw photos in the notebook, and the visiting caregiver can bring it back to the hospital for the child to read.
  6. Assign clinical family liaisons to update non-visiting caregivers or other family members on the patient’s status or call them during rounding.
  7. Family members who cannot be at a patient’s bedside may be comforted by visualizing the space their loved one is in. CHOC has a library of experience videos that can help family members – whether preparing for a visit themselves or not – learn more about CHOC.
  8. Setting up a CaringBridge page can help families share updates and photos with loved ones near and far.
  9. Use Zoom’s whiteboard feature to draw pictures together, write a story or play Pictionary.
  10. Use an online game sharing app to play your favorite board game together online. If a child doesn’t have a laptop available during their hospital stay, their child life specialist can help secure one to borrow.
  11. Pick a craft – anything from painting to decorating a coaster – that all family members can do together via Zoom or video call.
  12. Create a family gratitude journal, where each family member picks three things that they are grateful for every day. Share them with each other via a notebook that is carried from home to the hospital by the visiting caregiver, or with a free journaling app.
  13. Do a scavenger hunt via video chat with different family members. You can each try to find certain items in your spaces that start with a specific letter.
  14. Create coping boxes that kids can use when they feel sad or worried. Some items to consider adding are bubbles, coloring pages, Play-Doh and fidget spinners.
  15. Play a virtual game of Simon Says.
  16. Have family story time through video chat. You can do this at bedtime so family members not at the child’s bedside can participate in their bedtime routine.
  17. Have a virtual, interactive watch party for your favorite TV show or movie using Netflix Party or Disney+’s GroupWatch. These services allow you to synchronize your show or movie with friends and family, and chat while you’re watching.
  18. Create and send a personalized Build-A-Bear with a special “get well soon” message.
  19. Create virtual rooms together using Google Slides. Add furniture, people and links to different activities or games. There are many helpful and free tutorials online for creating these rooms.
  20. Create video diaries to keep each other updated on what you’re doing throughout the day – it could be something exciting or mundane. Share with each other via social media or use a free app to string together your video snippets throughout the day. There are also free apps that will allow you to create a calendar showing a photo of something fun or unique you did each day.